An Overview of Pituitary Incidentalomas: Diagnosis, Clinical Features, and Management

Abstract

Pituitary incidentalomas are tumors or mass lesions of the pituitary gland. These are incidentally discovered during imaging studies for symptoms that are not causally related to pituitary diseases. The most common symptom that triggers an examination is headache, and the most common type of pituitary incidentalomas are pituitary neuroendocrine tumors (PitNETs) and Rathke cleft cysts. The existing treatment strategy is controversial; however, surgical resection is recommended in cases of clinically non-functioning PitNETs with optic chiasm compression. In contrast, cystic lesions, such as Rathke cleft cysts, should be followed if the patients are asymptomatic. In this case, MRI and pituitary function tests are recommended every six months to one year; if there is no change, the follow-up period should be extended. The natural history of PitNET is partially known, and the management of pituitary incidentalomas is determined by this history. However, the pathogenesis of PitNET has significantly changed with the new World Health Organization classification, and follow-up is important based on this new classification. Therefore, a high level of evidence-based research is needed to consider treatment guidelines for pituitary incidentalomas in the future.

Pseudoacromegaly—A challenging entity in the endocrine clinic: A systematic review

“…These data suggest that pituitary abnormalities may be found in more than one‐third of cases, while adenomas can be incidentally found in about a fourth of cases. Most pituitary adenomas in the pseudoacromegaly setting have been detected in young patients (as early as 14 years old; mean age at diagnosis 25 years), population where incidentalomas are less common 64–66 . Pituitary incidentalomas seem common in pseudoacromegaly (more than in the general population 67,68 ), and typically correspond to small nonfunctioning adenomas without clinical significance 4,32,34,36,38,45,48,69 .…”

“…Most pituitary adenomas in the pseudoacromegaly setting have been detected in young patients (as early as 14 years old; mean age at diagnosis 25 years), population where incidentalomas are less common. [64][65][66] Pituitary incidentalomas seem common in pseudoacromegaly (more than in the general population 67,68 ), and typically correspond to small nonfunctioning adenomas without clinical significance. 4,32,34,36,38,45,48,69 Nevertheless, such pituitary incidentalomas require careful judgement to prevent inappropriate surgery.…”

Headache in patients with non-functioning pituitary adenoma before and after transsphenoidal surgery – a prospective study

“…In addition to visual-field defects from compression of the optic chiasm, headache is the most common symptom in NFPA [4], with a prevalence ranging from 33 to 72% [5]. Headache is also the most common symptom leading to investigation with computed tomography (CT) or magnetic resonance imaging (MRI) of the head, and discovery of a pituitary tumor [6]. Although pituitary tumor-associated headache is related to impaired quality of life (QoL) [7,8], headache is also a common symptom with many different etiologies across the general adult population [9].…”

Suggestion of Follow-Up Period in Nonfunctioning Pituitary Incidentaloma Based on MRI Characteristics

“…Pituitary incidentaloma (PI) refers to a lesion around the pituitary gland that is inadvertently detected during an imaging examination for reasons unrelated to pituitary concerns [ 1 2 3 ]. The name describes the fortuitous nature of its discovery, and PIs histologically correspond to a wide range of diseases [ 3 ].…”

“…The name describes the fortuitous nature of its discovery, and PIs histologically correspond to a wide range of diseases [ 3 ]. Pituitary adenoma is the most common neoplastic lesion and Rathke’s cleft cyst (RCC) is the most common cystic lesion [ 1 ]. With improved access to medical services and rapid advances in imaging technology, the prevalence of PI is increased [ 2 ].…”